C. Watching and Listening

by William E Buckley, Jr.

I had at school a most provocative professor who liked mean questions, meanly formulated, because be liked to make his stu­dents think—"an agonizing alternative in your case," he might have said. One day it was announced that medical science had come through with a cure for, I forget what it was: some form of pneu­monia, "What," the profes­sor said, "are we supposed to die of?" And indeed if it were all an abstract game, and we counted 977 extant terminal diseases for each one of which medical sci­ence in due course came up with a cure, that would leave us nothing to die from save just plain decomposi­tion of the flesh. It is gener­ally agreed, if I read science correctly, that this is the one process that cannot be arrested. Inevitably, human beings being rational ani­mals, thought is given to such questions as: Are there preferable ways to die than through biological decom­position?

A provocative book was published last year. It is Called Setting Limits, with the explanatory subtitle, Medical Goals in an Aging Society. Its author, Daniel Callahan, is what one calls a bioethicist, someone who considers the ethical impli­cations of biological devel­opments. Mr. Callahan is the director of the Hastings Center, which he founded, and which inquires into such questions as—well, setting "limits" to viable lifetimes.

Callahan tells us that at the current rate of increase in longevity, the cost of maintaining the most senior population in America will by the end of the century (which is not very far away) come to $200 billion a year. Mr. Callahan is not a penny-pincher, but his point is that we may be engaged in sub­sidizing a great deal of agony as the result of our preoccupation with keeping people alive at any cost.

Most Americans are familiar with the creeping availability of what the lawyers call "living wills". These vary from state to state but have in common their search for a legal instrument by which an individual can, with forethought, specify the condi­tions under which he desires to be permitted to die. What Callahan uniquely advances is the idea of a living will in effect generally accepted by society at large, and one that focuses on a particular age. For instance, how would one greet the propos­al that no publicly funded nursing home or hospital could finance a costly oper­ation (say a heart bypass) for anyone over the age of 85?

The prospect of a corpo­rate position on the right age to die is properly horri­fying. Callahan goes so far as to include as an accept­able stratagem the removal of food and water from old people who are insensate and would not feel the pain of their mortal deprivation. Such a proposal is shocking to moralist Nat Hentoff of The Village Voice_t who com­ments, "If an old person is diagnosed as being in a chronic vegetative state (some physicians screw up this diagnosis), the Callahan plan mandates that the feeding tube be denied or removed. No one is certain whether someone actually in a persistent vegetative state can feel what's going on while being starved to death. If there is sensation, there is no more horrible way to die." And then med­ical experts tell you that the cost of feeding insensate people is about the most inexpensive thing in medi­cine. True, it costs $20,000 a year to maintain someone in a nursing home. But to feed such a person through tubes costs only $10 per day.

The root question—here Hentoff wins the argument, I think—is moral, not

empirical. If life is a divine gift, as Christians are taught to believe it is, then inter­ruptions of it by acts of commission (suicide) or omission (a refusal to accept medical aid) are wrong. What the bioethicists search for is the ground in between. And the influence here of Pope Pius XII's exhortation in 1957 is criti­cal for many Catholics and non-Catholics. What he said was that although no one may collude in any act of suicide, neither is the Christian required to take "extraordinary measures" to maintain life. In the famous case of Karen Ann Quinlan in New Jersey, the priest and the courts autho­rized the removal of the res­pirator from the comatose patient (ironically, she lived on for nine years).

The whole business tor­ments, especially since more and more people have come into personal contact with the dying patient who comes to look upon medi­cine as a form of torture, given that its effect is to prolong life, and to prolong life for some is to prolong pain. No doubt, in the years to come, a working formula of sorts will emerge. It is critically important that it accept the moral implica­tions of the question, If a society is ready for euthana­sia, it has rejected the pri­mary attribute of life: name­ly, that it is God-given.